A Work In Progress: Virginia’s Efforts To Expand Mental Health Access

February 16, 2018 | By Megan Pauly

Virginia has one of the worst rankings for access to mental health care in the country – according to the Mental Health America.

“It might surprise you to learn that Virginia is ranked 42nd for access to care,” said Republican Senator Glen Sturtevant, speaking on the Senate floor this week about a bill that would exempt new psychiatric facilities from a state certificate process in an effort to expand access to care.

Applicants seeking to open new healthcare facilities and service centers in Virginia are required to prove there’s a need for their services – that what they’ve proposed makes sense and’s in public’s best interest – through a process called a “certificate of public need.” It’s been used in the state since the 1970s. Democratic Senator George Barker – who worked to review these specific applications for over 30 years in northern Virginia – says for the most part, the system is works.

“In the last five years there have been 24 applications for additional psychiatric beds…21 of those applications have been approved,” Barker said. “It’s not as if the commissioner of health has been turning down large numbers of applications.”

The legislation didn’t pass – and Julian Walker with Virginia’s Hospital and Healthcare Association says that’s a good thing.

“People say: well this will introduce more competition in the marketplace, this will lead to greater healthcare access in communities across the state, this will lower healthcare costs…and yet, what happens is the opposite,” Walker said.

Walker pointed to what happened in Pennsylvania: the state completely eliminated its certificate of public need process – but instead of leading to more hospitals and psychiatric facilities, both number actually declined. Regardless of the debate surrounding certificate of public need reform: lack of access remains a big problem for those seeking mental health treatment.

“In recent years, certain tragedies have happened that’ve made us really look at our system and really look at how we are serving individuals,” said Stephany Hardison with the Virginia chapter of the National Alliance on Mental Illness – also known as NAMI. While there isn’t a lack of total beds across the state, the beds that do exist aren’t evenly distributed – or staffed – especially in high-need areas.

“You may have a person that needs to be hospitalized and their local inpatient psychiatric unit may not be fully staffed. They may say well we have 20 beds but they’re only staffing 10 beds,” said Rhonda Thissen, Executive Director for NAMI Virginia. “So even though there may be beds vacant, there may not be staffing available for those beds. So there are a variety of reasons why people who need hospitalization end up in the state hospital when they’ve just been temporarily detained for an emergency evaluation. So it’s a complex problem. I think really the issue we need to look at is: do we have the right mix of services in the community and in the facilities to meet those needs.”

On top of that, private hospitals can deny care – and often send patients miles and miles to the closest state hospital. The law of last resort – passed in 2014 – requires state hospitals to accept all patients, regardless of their condition or previous medical history. Dr. Richard Bonne is Director of the Institute of Law, Psychiatry and Public Policy at the University of Virginia. He says there needs to be a greater emphasis on community-based, local care.

“The last thing we should be doing is adding more hospital beds – building more hospitals and investing more in the state hospitals. We already spend more of our public mental health dollar than most states in the country.”

There have been some recent steps taken to improve access to mental health care at the local level. This past summer, Former Governor Terry McAuliffe signed legislation requiring all 40 of the state’s community mental health centers to provide same-day access services by 2019.

“If you can respond today, you’ve got a chance of engaging them in treatment,” said Daniel Rigsby, Director of Clinical and Prevention Services for Henrico County’s community health centers. “But if you say, I’m sorry, you got to wait four days, chances are that there something’s going to have happened and they’re not going to be at that same point of readiness.”

Henrico was one of the first local mental health centers to receive state funding in order to be able to provide this same day access. But Rigsby says they had started implementing the model before the state got on board – and says the process has totally transformed the way they provide care.

“So it’s really a huge restructuring of not just how people get into services, but it means the front desk staff has to be prepared for somebody just walking in and saying, I need help right now. It means our whole business process has to be different about how do we get people checked in and enrolled in services,” Rigsby said. “We have to have clinical staff available whenever people show up.”

And so far, the results have been positive. From May through December of last year – over 1,600 individuals received a same-day assessment, and were given a second appointment within the next 14 days. And – Rigsby says people came back for the second appointment.

“We were worried that people were kind of going, well, I already told you my story. I don’t know what. I’m not going to go to somebody else, but we just have found that not to be the case at all, that people are engaged, they want to get treatment, they want to get connected and they follow through.”

Not only did it increase same-day access, but led to a dramatic increase in utilization of mental health services across the board – from young adult treatment, adults and even a 10% increase for those with substance use disorders.

But Henrico is one of only 18 health centers that’s been allocated state funding for same-day access. Funding for the other 22 centers hangs in the balance of budget negotiations at the state Capitol. Senator Creigh Deeds is optimistic – but cautious. “That’s where I want to go, but, but I also understand that politics involves a lot of compromise and there are a lot of cooks in the kitchen so to speak,” Deeds said. “I probably won’t get everything I want.”

The House and Senate are expected to unveil their budgets this Sunday. Megan Pauly, WCVE News, Capitol Square.